Provider Demographics
NPI:1861544348
Name:BANKS-MOHR, DIANE I (LCSW)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:I
Last Name:BANKS-MOHR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:INEZ
Other - Last Name:MONTOYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:84 OHIO ST
Mailing Address - Street 2:STE 3
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1806
Mailing Address - Country:US
Mailing Address - Phone:406-646-2470
Mailing Address - Fax:406-299-3911
Practice Address - Street 1:84 OHIO ST
Practice Address - Street 2:STE 3
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1806
Practice Address - Country:US
Practice Address - Phone:406-291-5805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT711LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT70226OtherBCBSMT
MT28236Medicaid
MT011000841Medicare PIN